Fill and Sign the Texas Acknowledgment of Protest Form

United States of America State of Texas County of ____________ Be it known that on the ______ day of _________, 20____, at the request of _____________ (name), of ___________, I ___________ (Notary Public’s name), a Notary Public duly commissioned and sworn, residing in __________ County of Texas, did present the original_______________ (instrument), hereto attached, for $_______, with accrued interest thereon of $___________ dated ________, and demanded payment (or acceptance) thereof which was refused. Whereupon I, at the request of the aforesaid __________, did protest, and by these presents do protest, as well against the drawer, maker, endorsers, and acceptors of said instruments as against all others whom it may concern, for exchange, costs, charges, damages, and interest already incurred and hereinafter to be incurred by reason of non-payment thereof. I further certify that on ________ (date), notice in writing of the foregoing presentment demand, refusal and protest was given by ____________________ (persons and status) by depositing notices thereof in the post office at _______________, Texas, postage paid directed as follows:______________. I further certify that notices were left as follows: Notice left for ____________ at __________________. Notice left for ____________ at __________________. Each of the named places the reputed place of residence of the person for whom the notice was left. In testimony whereof I have hereunto set my hand and affixed my seal of office at ____________ at ___________, Texas, on _______ day of ____________, 20____. ______________________ (seal) Notary Public Signature